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Becker’s Healthcare Podcast
Advancing Real World Wound Care with Dr. Jaideep Banerjee of Smith+Nephew
00:19:35
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- [00:00]
A
Hello everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series today. So today we're going to explore real world wound care, examining the latest research, the challenges that healthcare organizations face, and the strategies that can improve outcomes while also reducing costs. And joining me for this conversation is Dr. Jaydeep Banerjee, Director of Global Clinical and Medical affairs at smith and nephew. Dr. Banerjeet, thank you so much again for being here today. Welcome to the podcast.
- [00:34]
B
Thank you, Erica. It's a, it's a pleasure and honor to be on this, so thank you for inviting me.
- [00:38]
A
Oh, well, we're really happy to have you here. And before we get into the heart of our conversation, I wanted to give you the chance to share a little bit more about yourself and your work in healthcare with our listeners.
- [00:50]
B
Yes, happy to do that. So I entered the world of wound care while I was doing my PhD in molecular cell and Developmental Biology from the Ohio State University in Columbus, Ohio. During my PhD, I worked on genetic signaling during the wound healing process, the effect of oxygen, or rather the lack of a that often happens during chronic wounds, the impact of biofilms and how to tackle it. So I've been working in the space of wound care or wound healing research for almost 18 years now. So continued working on these different aspects during my postdoctoral fellowship at the U.S. army Institute of Surgical Research in Texas and then George Washington University in Washington, D.C. i've also worked as a consultant with Walter Reed and Michael Callahan Military Medical Center. And then from Preclinical Research, I joined a company called Osiris Therapeutics in the Medical affairs division working on skin substitutes. This then became part of Smith and Nephew. That's how I came into Smith Nephew. Smith and Nephew, as you, as many of you may know this as they have been in the wound care business for over 175 years starting from before World War I. And it's really a privilege to continue working in this space with a company with such a rich legacy and a big portfolio of products. Because as you know, wound, wound healing or wound care is not just one product. I as you mentioned, I'm currently a director for Medical affairs and me and my team, we help advance wound care education and the scientific understanding behind our technologies. And I'll also say I try to give back to the research community by serving as a peer reviewer and editor for number of journals including Advances and Wound Care, which is one of the topmost journals in the space. So it has been an honor and privilege so far to be contributing in the space.
- [02:54]
A
Dr. Banerjee, great to learn a bit more about you. And it sounds like you are bringing a lot of passion to this area of expertise. As you mentioned, a lot of time and dedication to the research area as well, and wound care and wound research. I know it's such an important space, it always has been, but it's increasingly being cited as a quality of care concern and a significant cost driver for many hospitals and health systems. So I, I think having your insights on this podcast today is going to be so valuable. I'd like to start off by asking, from your perspective, how are healthcare organizations approaching the challenge of wound care today and some of the challenges and cost drivers, as I mentioned, that are associated with it?
- [03:39]
B
Yeah, you're absolutely right. You know, chronic wounds are considered a silent epidemic in the United States, to be fair, across the world. Right. So in the U.S. the most recent data says that almost one in six Medicare beneficiaries, almost, and that that's almost ten and a half million people, 11 million people who will be suffering from a wound at some point, a chronic wound at some point. And this costs Medicare almost, you know, 22 to 23 billion dollars annually. So that's a, that's a huge burden on our healthcare system. And a lot of the times it's not just one wound. The wound, even when you think it has closed, it will recur, it will open back up due to incomplete. He. And, and what do you mean, what do you, what do you mean by incomplete healing? A lot of the time it, it, it would close superficially through a process called epithelialization. But if there is, if, if it doesn't heal from bottoms up in, in scientific terms, you know, if you don't have a good granulation tissue, good wound bed, anytime there is another stress on that wound, that wound will open back up. So, you know, to consistently improve these wound care outcomes, researchers, healthcare organizations, we are, we are all trying to understand how to standardize wound care. And I think that's a big problem in the wound care space, that the standard of care is not well defined. Some of it may relate to, you know, surgical practices, wound care practices, but also a lot of it depends on compliance, on patient education, on. So, so, so together we have to work together to help improve the outcomes. But, you know, despite best efforts, again, I mean, as I mentioned, standards vary significantly, and a lot of that can be improved if there is not only health care provider education, but also patient education to help take care of the wounds, the doctor can help the patient to some extent, but the patient have to help themselves to help that wound heal. So by understanding these factors, what causes a wound, what affects these wounds, how to keep that wound closed, I think that is how we develop a standardized, evidence based patient care, patient centers practice to improve wound care outcomes across the nation.
- [06:03]
A
Yeah, it certainly sounds like there are a lot of factors that require deep understanding from the patient side, the provider side, operationally speaking. And Dr. Boehner, GIs understand you also recently co authored a study that looks at wound care outcomes in a real world setting. So I'd love to hear from you more about what inspired that research and questions that you were hoping to answer in that study.
- [06:28]
B
Yeah, so as I said, standard of care has not yet been very well defined. But one thing that everyone seems to have a consensus on is the need to ensure good wound bed preparation before and if there is a need to move on to different advanced wound care modalities. So, you know, when you talk of good wound bed preparation, the gold standard is what is called debridement. So you need to take, you need to get rid of necrotic tissue or your dead necrotic tissue in the wound. And while there are different debridement modalities, one of the debridement modalities is enzymatic debridement. And this paper that we worked on involves an enzymatic debrider that, that is called Clostridium collagenase. This is an enzyme that is derived from a particular species of bacteria and it has certain advantages. While this is something that works more slowly, obviously than something like a mechanical debridement or a sharp debridement, it is also a relatively pain free modality to remove the necrotic tissue, which is very, very helpful for a lot of patients who are more sensitive to pain in these burn wounds or a lot of these chronic wounds. Also while, while, while we started off by knowing that this is a good debrider over the last couple of decades and people have continued studying this, this enzyme and this, this product and what they have found that, you know, a number of scientific papers have now been published where they see that the effects go beyond debridement. And what these scientists have reported is that collagenase, this enzyme and its byproducts, what happens is this collagenase can go and cleave human enzyme in multiple different fragments. And these byproducts have been shown to promote a favorable inflammatory response, support extracellular matrix Remodeling generate different peptides that stimulate tissue repair. So it looks like that there is an effect that is happening beyond debridement. And while a lot of our clinical data looks at, you know, how well it is, debriding and the healing outcomes in the long term, I think what we want to do in this real world study is go a little bit more granular and investigate what happens immediately after you put this enzymatic debrider on. And what are the, you know, the wound outcomes in that early, I would say two to four weeks right after central application. Central is the, is the synthetic debride that I'm talking of. So that was the goal of this study. The motivation was these new scientific papers that have come out which suggests that there are additional cellular and molecular signaling happening in the wound bed. And we wanted to see if that clinical outcome, so that initial phase right after that central application ties to what we are seeing in the laboratory.
- [09:35]
A
Yeah, thank you so much for the overview, Dr. Banerjee. Really interesting study premise here. And so as were looking at the results of the study, what do you think stood out to you the most? And can you kind of connect the dots for us here on what it means for patients, clinicians and health systems more broadly? Yeah, sure.
- [09:54]
B
So, so, and it's, it's just fascinating that a product that's been in the market for, you know, almost 50 years, we're still learning new things about this. Right. So you know, what we found in this study, I think, I think summarizing it very broadly, this study included almost 16,000 patients each having on an average about two wounds, almost 30,000 wounds from a net health registry database. So these are all patients who have received the central ointment between approximately 2020-2023. So a significant number of patients. And we are looking at different kinds of wound here. There are burns, there are diabetic foot ulcers, venous ulcers, pressure ulcers, surgical trauma wounds and wounds of different sizes as small as 0, 10, 20 centimeters square to as large as 1,000, 2,000, up to 5,000 centimeters square wounds. And what we found from the analyzing data is that irrespective of wound size or wound type, there was a consistent reduction in wound size in these patients who have been treated with center. And on an average, what this data suggests is there was almost a 15 to 20% reduction in wound size in that initial two weeks, about 40% reduction in wound size in that four weeks. And why this two weeks or four weeks on an average what we know a patient being discharged from the hospital in the US is on an average that two to three weeks timeframe. So this gives us an idea that, you know, typically a treatment like central is most often used in the outpatient settings. But what this data suggests that starting therapy, you know, even during the inpatient stay in that initial two to three weeks, this can help drive, you know, earlier progress and better outcomes post discharge. So I think that was something that was eye opening and hopefully that is a data that helps physicians take more educated decisions on when and how to use this product.
- [12:10]
A
Yeah, that's so helpful to know. And you know, as leaders are especially concerned with things like, you know, timely discharges and hospital stay length, I think that those findings are certainly something for folks listening in to consider. So thank you, Dr. Banerjee, for elaborating on those results a bit more, more for us.
- [12:30]
B
And Erica, if I can also add to this, you know, I mean, a lot of the times once this initial debridement has been done, physicians would move to, as I mentioned in the earlier, like move to advanced modalities, like, you know, for example, something like using these cellular and tissue products or you know, skin substitute or as they're called, cams. And I think what this data can also suggest is that something that we found, you know, these, these patients who had Centrum, we were also looking at, if they had advanced modalities. And looking at some of the data, it also suggests that if you have a good womb bed preparation, you might be again saving costs in the, in the later phase of your, of your managing these wounds by probably needing lesser number of skin substitute or lesser number of advanced modalities. This is almost if you have a good foundation, then your end outcome will be better is what this data suggests.
- [13:34]
A
Yeah, that makes a lot of sense. So Dr. Banerjee, as you think about what you've learned, this kind of proactive approach to wound bed preparation and treatment, if you could distill one thing that healthcare leaders should take away from this or keep in mind in the next year to improve wound care outcomes, what would you say that one takeaway is? Sure.
- [13:56]
B
So, you know, in wound care there's a concept called time. And time here is, you know, I'm calling time as an acronym here. And so what I mean by T and I and M and E is for a good algorithm for wound care, you have to start with T, which is taking care of that necrotic tissue. So that involves debridement. Then what we believe is what is Called eyes. So taking care of the infections, the infection management, resolution of the inflammation, followed by M, which is moisture balance. A wound, you do not want it to be too wet or too dry. And then followed by you're trying to move the wound edge or trying to epithelialize. So as you see, it starts with T, it starts with a good debridement. And I think this is what I was trying to think of a good analogy. You know, it's almost like if you're trying to paint your house, you need to do your sanding first and then apply a primer before you want to apply your paint so that your paint sticks there. So this is the same concept here, that if you are, if you're trying to use an enzymatic debride like central, you're not only taking care of that T, where you're removing that necrotic tissue, but you're also building up that granulation tissue as needed for these for later cells to migrate on and form that epithelial layer and stay closed. So it's all about not only just superficially closing on, but making sure your quality of healing is better. So I think healthcare providers should remember to ensure a good debridement. And central is just a modality. There are different tools available to all of us, but the point is to ensure that there is a good debridement and build a good granulation tissue. And I think that will go a long way in closing the wound, keeping the wound closed, and ultimately reducing the cost of care in the long run. Because, you know, as we often make a mistake that, you know, we often think, oh, this is an expensive product to use upfront. And what we have all understood as researchers, that even if some of the upfront cost is high, if you leave or if you, you know, if you risk keeping a wound unhealed or not closed, the risk of not closing on fast enough can actually be even more costly at the end. And, you know, so health care providers, as I started out by saying, they should focus on the evidence to drive home care decisions. And it is not only about education for the healthcare providers, but then also passing the education onto the patients so that they also know that they need to be compliant with the wound care protocols and they need to take care of the wounds. And so together we can make sure that our costs are down and we are able to, you know, heal more number of wounds.
- [16:55]
A
Dr. Banerjee, this has been such an, such a fascinating conversation. So I want to thank you for sharing your insights from your latest research today and shedding light on this issue too, of wound care and chronic wound care and what these implications are if providers aren't investing in the time and care upfront. Really sounds like a proactive approach here is quite critical. So I just wanna thank you again for your time and for highlighting some of these important factors for our listeners today.
- [17:24]
B
Of course, thank you for giving us the opportunity to talk about this research. Thank you again.
- [17:29]
A
Absolutely. And we'd also like to thank our podcast sponsor for today, Smith and Nephew Important Safety Information Indication Collagenase Santol ointment or Santol is indicated for debriding chronic dermal ulcers and severely burned areas. Contraindications Santol is contraindicated in patients who have shown local or systemic hypersensitivity to collagenase. Warnings and Precautions the optimal PH Range of collagenase is 6 to 8. Higher or lower PH conditions will decrease the enzyme's activity and appropriate precautions should be taken. The enzymatic activity is also adversely affected by certain detergents and heavy metal ions such as mercury and silver, which are used in some antiseptics. As such, the wound should be properly cleansed prior to application of Santol. Debilitated patients should be closely monitored for systemic bacterial infections because of the theoretical possibility that debriding enzymes may increase the risk of bacteremia. A slight transient erythema has been noted occasionally in the surrounding tissue, particularly when Santol was not confined to the wound. Santol is not indicated for wound closure. Discontinue use of Santol after granulation tissue is well established. Adverse Reactions no allergic sensitivity or toxic reactions have been noted in clinical use when used as directed. The risk information provided herein is not comprehensive. To see the complete prescribing information, please see the FDA Approved Approved product labeling at www.santel.com PDF santel-PI PDF. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088 listeners. Be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast page at BeckersHospitalReview.com.